1/7. vertigo secondary to isolated pica insufficiency: successful treatment with balloon angioplasty.BACKGROUND: The posterior inferior cerebellar arteries (pica) arise from the intracranial segments of the vertebral artery (VA). We report a case where a nondominant isolated vertebral artery, which terminated in pica, was stenotic. This resulted in brainstem-lower cerebellar ischemia, corrected with balloon angioplasty. CASE DESCRIPTION: A 62-year-old male presented primarily with transient vertigo, syncope, and dizziness and was diagnosed with transient ischemic attack. angiography of the left vertebral artery (VA) demonstrated a small-caliber vessel terminating in pica with a 90% stenosis at the C6 level. angioplasty of the left VA was performed with excellent resolution of the stenosis. CONCLUSIONS: This case illustrates cerebellar insufficiency in a unique case where the pica was isolated, supplied by a small- caliber VA. Correction of the stenosis improved the patient's symptomatology and prevented an inferior brainstem-cerebellar infarction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Thyrocervical trunk-external carotid artery bypass for positional cerebral ischemia due to common carotid artery occlusion. Report of three cases.Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Coarctation of the abdominal aorta in a child: morphometric analysis of the arterial lesion.Coarctation of the abdominal aorta with associated narrowing of the origin of major visceral arteries is a rare cause of life-threatening hypertension. We describe a 9-year-old male with hypertension and recent onset of headache and dizziness who was subsequently found to have a suprarenal coarctation with involvement of the proximal renal arteries. The patient died following a left cerebrovascular accident associated with recent thrombosis in the left middle cerebral and internal carotid arteries. Morphometric analysis of the aortic coarctation revealed that a reduction in outside diameter of the vessel was complicated by marked intimal thickening which caused further stenosis of the lumen. Medial thickness was constant, and elastic fibers of the media were intact at the level of coarctation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. dizziness after head trauma: clinical and morphologic findings.Twelve patients with balance problems resulting from head injury were treated by a translabyrinthine or middle fossa vestibular neurectomy. The clinical, otoneurologic, and surgical data combined with morphologic findings on the removed operative eighth nerve specimens were evaluated with the aim of deciding the site of primary lesion in each case. In six patients a peripheral lesion was interpreted. Four of them had features of delayed endolymphatic hydrops syndrome, the fifth patient might have suffered a fracture of the stapedial footplate with associated perilymphatic fistula. The sixth patient had a deforming fracture of the internal auditory canal that had produced severe hearing loss and constant unsteadiness because of the compression of the eight nerve, which had atrophied as a result. Half of the patients were diagnosed as having a central lesion. Only one of them benefited from the neurectomy. This patient had a large arterial loop within the internal auditory canal and the symptoms may have arisen because of friction of the vessel of the proximal portion of the vestibular nerve. The other five patients probably had a lesion at the level of eighth nerve brain-stem junction or central to it.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. motion sickness: part II--a clinical study based on surgery of cerebral hemisphere lesions.Man has always been intrigued with the localization of function within the brain but has paid insufficient attention to the long and the short association fiber pathways which, when stimulated, may fire distant areas evoking unusual responses. Three cases of intracerebral lesions are presented to demonstrate the significance of these structures. The vestibular symptoms of dizziness may occur from excitation of the temporal operculum. If, added to this symptom, the patient has spatial disorientation, such as feeling upside down, it suggests that the region of the supramarginal gyrus and the angular gyrus are involved. When unformed visual hallucinations (such as flashes of light) or formed hallucinations (such as distorted images) are present the occipital and midtemporal regions of the brain, respectively, are considered to be the sources of such responses. The symptoms described above were reminiscent of those experienced by some of the cosmonauts and astronauts and it called the authors' attention to this "motion sickness in space." The areas from which such responses may be elicited are the temporoparieto-occipital regions, which are nourished by the posterior cerebral artery and its branches. Vascular insufficiency to this area by spasm of the vessel may be responsible for this symptomatology.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Post-dural puncture thoracic pain without headache: relief with epidural blood patch.We report two unusual cases of postural, post-dural puncture upper thoracic interscapular backache, without headache, that were relieved by epidural blood patching. There is controversy concerning the aetiology of headache associated with the post-dural puncture syndrome. Mechanisms previously proposed have included traction on pain-sensitive intracranial structures such as the dura or blood vessels, or a vascular mechanism which may be adenosine-receptor mediated. These two cases suggest that traction on cervical or upper thoracic nerve roots should be considered as a possible mechanism of pain in the post-dural puncture syndrome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Percutaneous stenting for symptomatic stenosis of aberrant right subclavian artery.Aberrant origin of the right subclavian artery is the most common abnormality of the aortic arch vessels and occurs in approximately 0.5% to 1% of the population. Symptoms can result from compression of the esophagus by the aberrant vessel, aneurysm formation, or atherosclerotic occlusion. Occlusive symptoms are typically relieved by surgical revascularization (i.e., transposition or carotid-subclavian bypass) through a cervical approach. An alternative approach to the management of stenosis of normal subclavian arteries is percutaneous angioplasty and stenting, an approach not previously used for occlusive disease of an aberrant right subclavian artery. We describe a case of focal stenosis of an aberrant right subclavian artery causing dizziness and arm claudication in a patient who underwent successful percutaneous angioplasty and stenting.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |